Long-term complications following surgical patch closure of multiple muscular ventricular septal defects

Hofmeyr, L., Pohlner, P. and Radford, D.J. (2013) Long-term complications following surgical patch closure of multiple muscular ventricular septal defects. Congenital Heart Disease, 8 6: 541-549. doi:10.1111/chd.12038

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Author Hofmeyr, L.
Pohlner, P.
Radford, D.J.
Title Long-term complications following surgical patch closure of multiple muscular ventricular septal defects
Journal name Congenital Heart Disease   Check publisher's open access policy
ISSN 1747-079X
Publication date 2013-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1111/chd.12038
Open Access Status Not Open Access
Volume 8
Issue 6
Start page 541
End page 549
Total pages 9
Place of publication Hoboken, NJ, U.S.A.
Publisher Wiley-Blackwell Publishing, Inc.
Language eng
Subject 2705 Cardiology and Cardiovascular Medicine
2735 Pediatrics, Perinatology, and Child Health
2746 Surgery
2741 Radiology Nuclear Medicine and imaging
Abstract Background: Multiple muscular ventricular septal defects (VSDs) in children can be difficult to treat and a range of techniques has been advocated. These include pulmonary artery banding, interventional catheter closure, and a variety of surgical approaches. When there are apical muscular defects and associated coarse trabeculations in the right ventricle (RV) producing a "Swiss cheese" pattern, a large patch extending on to the RV free wall and excluding part of the apex has been used. Methods: We assessed four adult patients who had surgery 22 to 45 years ago to treat muscular VSD by patches which excluded the RV apex. Results: Ages ranged from 22 to 50 years. Re-presentations were for polycythemia, cyanosis, syncope, and atrial flutter. Echocardiography showed bidirectional flow from left ventricle to apex of RV, no pulmonary hypertension, small-sized RV with diastolic dysfunction, enlarged right atria, reopening of patent foramen ovale (PFO) in three, and positive bubble studies with right to left shunting in two. Catheterization confirmed elevated right atrial and RV end diastolic pressures. Two patients had evidence of hepatic cirrhosis. One woman had device closure of PFO, but has right heart failure. One man had redo surgical closure of VSD and PFO. Another patient is being considered for a Glenn shunt to take some load off RV. Conclusions: Surgical closure of muscular VSD by large patch with RV apical exclusion gives good early results. However, long term in adult life, the reduced size of RV, and diastolic dysfunction cause problems. These include reopening of PFO with cyanosis, right heart failure, cirrhosis, and arrhythmias.
Keyword "Swiss Cheese" Ventricular Septal Defects
Adult Congenital Heart Disease
Multiple Ventricular Septal Defects
Muscular Ventricular Septal Defects
Patch Closure of Ventricular Septal Defects
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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Created: Wed, 30 Apr 2014, 10:10:09 EST by Matthew Lamb on behalf of School of Medicine